A gentler breath of fresh air for premature babies

Nearly 13 percent of U.S. babies are born prematurely, according to a recent report from the March of Dimes. These babies face a host of health problems – including taking their first breath, which for a premature newborn can be difficult if not impossible. Preemies are frequently placed on ventilators to pump oxygen into their tiny, immature lungs, but this treatment is often part of the problem: the constant air pressure from the ventilators can cause inflammation and lead to chronic lung disease. Now, however, there’s an alternative.

Bernadette Levesque, MD, of Children’s Division of Newborn Medicine has built a “bubble” setup known as Continuous Positive Airway Pressure (CPAP). The device delivers warm, humidified oxygen to preemies in a much gentler fashion. In a recent study, Levesque found that it safely reduced the need for mechanical ventilation from 52 percent of babies to just 11 percent, significantly improving their health outcomes.

While a definitive randomized study may be needed to get other NICUs to adopt bubble CPAP, Levesque doesn’t need any convincing. “We have seen first hand how well this approach works,” she says.

Laboratory studies provide support for the idea that putting less pressure on the lungs might actually help. Experiments have shown that physically stretching the cells in the lungs – the way a mechanical ventilator does – causes them to make less of a protein that’s necessary for blood vessel growth in the lungs. Levesque found that preemies on ventilators had lower levels of this protein in their urine. Looking to the future, she speculates that urine testing for this protein might help in diagnosing chronic lung disease, and that restoring the protein in the lung might help in treating preemies with lung problems.